Case Study: Implementing a Successful CDI Initiative
For a client, Shearwater Health addressed clinical documentation improvement (CDI), leading to improved documentation, more accurate CPT coding, improved care quality, better quality core measures, and higher reimbursement.
Client: Large, Complex Multispecialty Practice
Shearwater Health focused on documentation improvement opportunities through analyzing the data in the entire medical record of a group of sixty physician clinics with a wide range of specialties. Additionally, Shearwater Health focused on the client’s CPT coding accuracy for evaluation and management codes.
Shearwater Health used a team of trained, licensed coders to identify opportunities for its CDI initiative. Shearwater Health’s coders were AHIMA and AAPC certified coders focusing on inpatient, outpatient, ED, professional fee, HCC/risk adjustment, and CDI support. The team included coders with one or more of the following credentials: CSS, CPC-I, CCS-P, CPC, CPC-H, COC, CIC, HCS-D, and CDI-P.
Shearwater Health’s Key Deliverables
To address the pressing need for CDI initiatives within the client organization, Shearwater Health focused on strategic key deliverables that highlighted common issues that large provider groups and health systems face:
- Record review: Shearwater Health’s team reviewed all clinic records spanning every service—thousands of records and hundreds of thousands of codes.
- Key clinical documentation gaps: A 2015 Clinical Documentation Improvement Trends Survey of large provider group professionals found that 98.5 percent of the respondents believed their physicians could improve on documentation practices. Furthermore, the survey indicated that the primary barrier prohibiting physicians from engaging effectively in CDI is a general lack of understanding of strong documentation.
- Query opportunities: The Shearwater Health team’s review included flagging files that required physician query for completeness, accuracy, and billing opportunity and standardizing physician-query best practices for the sixty clinics.
- CPT accuracy: Complexities within the CPT coding guidelines and a lack of physician training account for prevalent errors. A study of 600 family physician members of the Illinois Academy of Family Physicians uncovered that 16 percent were over coded and 33 percent were under coded. Often, documentation doesn’t support the services billed. Other common errors come from incorrect coding, prolonged services, time-based services, and duplicate submissions.
- Revenue impact: All CDI initiatives should positively affect revenue, with the largest ROI possibilities receiving top priority. Estimates for large hospital systems indicate that CDI and billing programs could increase annual revenue by $2.5 million.
- Coding and documentation improvement: The possibilities for improving coding and documentation are myriad within all provider organizations—and especially so in large, complex provider groups.
CDI Initiative Findings
Shearwater Health determined that 29 percent of the client’s clinical cases had an opportunity for CDI.
Opportunities included the ability to:
- rank clinics by documentation improvement opportunity,
- categorize common documentation gaps, and
- build a physician education plan focused on specific gaps for the service line.
In addition, 10 percent of cases presented a query opportunity, confirming the need to build a physician education plan.
Addressing these opportunities resulted in solid quality data and business intelligence that help the client increase efficiency, improve revenue, and make better long-term business decisions.
Implementing CDI Initiatives
Your CDI initiative should take a long-term view of the areas for documentation improvement and the ability for programs to achieve a return on investment.
Shearwater Health has the extensive experience you need for CDI initiatives. Contact Shearwater Health today: firstname.lastname@example.org or 615-921-9510.
You’ll be impressed with how we can help you.